LAUSR

OBJECTIVE The purpose of this systematic review is to identify the operative issues and specific dysmenorrhoea and menorrhagia outcomes in women who had fertility sparing surgery, as well as the expected oucome for extirpative disease. DATA SOURCES PROSPERO (ID No 125692). Search for eligible studies up to 31 March 2019 on Medline/PubMed (1966-2019), Scopus/Elsevier (1950-2019) and Google Scholar (up to 2019). The search terms applied for the search strategy were: adenomyosis, adenomyomas, uterus-sparing surgery, fertility sparing surgery, pain, dysmenorrhoea, menorrhagia, uterine volume, adenomyotic volume, case-control studies, cohort studies, prospective studies. METHODS OF STUDY SELECTION 443 studies were initially identified. EXCLUSION CRITERIA (a) inadequate description of pre-operative adenomyosis or absence of post-operative histology confirmation of adenomyosis, (b) no statement of use of a standardized instrument for measurement of pain, bleeding, or adenomyotic/uterine volume, (c) follow-up <12 months post-operatively, (d) study population <20 women, (e) non-English language. TABULATION, INTEGRATION AND RESULTS Nineteen studies with a total of 1843 patients with adenomyosis were included. Twelve studies were further anayzed in the meta-analysis. Complete excision of adenomyosis is related with improvement in pain, menorrhagia, and the reduction of uterine volume by a factor of 6.2, 3.9, 2.3, respectively; the partial excision of adenomyosis is related with improvement in pain, menorrhagia, and reduction of uterine volume by a factor of 5.9, 3.0, and 2.9, respectively; the studies with a mixed volume of patients with complete and partial excision of adenomyosis report improvement in pain, menorrhagia, and reduction of uterine volume by a factor of 4.0, 6.3, and 5.1, respectively. CONCLUSION In conclusion, the surgical treatment of adenomyosis results in satisfactory control of the pain and bleeding, as well as in the reduction of the uterine volume. Further research is warranted in order to investigate the long-term control of symptoms, to identify any parameters related to the recurrence of adenomyosis, as well as in order to compare the conservative surgical treatment of adenomyosis with other treatment options.